AOA: Proactive legislation needed to ensure access to care, clinical registry in development
PHILADELPHIA – While a number of states have passed legislation granting laser and injection privileges and protection against managed care plan dictates, “there’s a huge complacency issue,” the American Optometric Association State Government Relations Committee chair told the House of Delegates.
“Big issues continue,” Deanna Alexander, OD, told the delegates here at Optometry’s Meeting. “Ophthalmology has been trained to attack our profession, and we’ve been able to avert these attacks because of our strong relationships with legislators.
“We have the same agenda that you have,” she continued. “It’s about access. It doesn’t feel good to not be able to provide your patients with the services they need.”
Alexander said hydrocodone will be reclassified from a Schedule III to a Schedule II agent, which can be considered as a loss of scope.
“Health care and technology changes will occur and you may be left not being able to take care of your patients,” she said. “Let’s be proactive and change our laws ahead of the game.”
Scope of practice challenges along with insurance and vision plan legislation will continue, as will issues of consumer protection, kiosks, online exams, telemedicine and Medicaid, she said.
“The State Government Relations Committee is strong, with many years of legislative experience,” Alexander said. “We will come to your state and train your legislative advocacy team, work grass roots – whatever you need us to do. If you haven’t passed legislation in 10 years or so, see where you’re at. We can help model language for legislation for vision plan regulation and disruptive technologies.”
Beth Kneib, OD, director of the AOA’s Clinical Resources Group, told the delegates that a clinical registry is being developed “for the purpose of empowering you to make the best clinical decisions for your patients.”
She said that the Centers for Medicare and Medicaid Services will go beyond the Physician Quality Reporting System (PQRS) to a value-based system.
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“We’re working with advocacy to make sure PQRS is coded through the registry, but also that we’re collecting the right data,” Kneib said.
More than 75 associations are currently using registries, she said.
“We know the world is going to big data systems,” Kneib said. “We know we need to make PQRS reporting easy for you. We’re leaving money on the table that we don’t report.
“At the same time we want to make sure we’re participating in care coordination and that others know what we do and how well we do it,” she said. “Eye care numbers aren’t being counted.
“All of us do what’s right for our patients,” Kneib continued. “Data helps drive quality improvement.”
She noted that the registry reports include no patient identifiers.
“The managers of the registry will only see cumulative data,” she said. “We’ll look for trends, gaps, improvement areas, education and research areas, but mostly at how we’re doing as a profession so we can prove we can take on more as you look for expanded scope of practice.”
The chair of AOA’s Optometry Registry Committee is Jeff Michaels, OD, Kneib said, and the registry will come to optometrists in early 2015.
Steve Montaquila, OD, chair of the AOA’s Third Party Center, told the House of Delegates that optometrists’ biggest opportunity now is with integrated health systems and accountable care organizations (ACOs).
“They are just now looking outside their primary care structures to see who can take care of their needs,” he said.
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The Third Party Center has created a toolkit to explain what an ACO is and how to participate, he said.
“There’s a list of existing Medicare-sanctioned ACOs and key contacts in your area,” Montaquila said. “This will help you find out who to talk to.
“We just signed a deal in my state to provide eye care for an independent practice association,” he said. “I tested out the message the AOA has available, and I can tell you that it works.”
AOA Federal Relations Committee chair, Roger Jordan, OD, said his group has “been working with every single agency in Washington to achieve a great deal for the profession. We have the pediatric vision benefit implemented as a comprehensive exam; we’re taking on insurers and medical interest groups who are working to undermine the nondiscrimination provision.”
Jordan said optometrists are making 83% more on Medicare physician services than in 2004, a difference of $500 million.
“Lawmakers have introduced certain proposals to fix the flawed sustainable growth rate formula, which we are all for,” he said. “All of them maintain the fee schedule, but have an increased focus on emphasizing quality over quantity. From the start, the AOA made it clear its position was nonnegotiable. We indicated any reform plan must protect patient access to optometry while insuring equitable pay and fair treatment.”
In the past, many states complained of restricted access to medical care through Medicaid, Jordan said.
“Lately, we haven’t been hearing any,” he said. “Please let us know if this is happening. Unless we hear compelling reports, we probably will not introduce the Medicaid Act as a piece of legislation. The overall goal is to have optometry recognized in Medicaid as full physicians as we are in Medicare.” – by Nancy Hemphill, ELS